Perfecting The Art of Dispensing from the Exam Chair

One key to success is practicing a communication style
I call the ‘baton pass’ from the doctor to the optician.

By Peter Kehoe, OD, Galesburg, Ill.

A COUPLE OF years ago, I coined the phrase doctor-driven dispensing — a method of practice that involves giving expert vision correction recommendations to patients for the best visual outcomes. I coined this phrase because I often heard optometrists say, "I don't have time to discuss lens options with patients," or "It isn't worth making suggestions because of the paltry reimbursements I receive from managed vision care plans," or "I'm a doctor. I leave eyewear recommendations to my staff."

Unfortunately, if you subscribe to this line of thinking, it will prevent you from taking advantage of a huge opportunity to increase patient satisfaction, raise your level of professionalism, build patient loyalty and grow your practice. As optometrists, our history and education demonstrate that we've always been the experts in vision correction, which remains a chief complaint and the primary reason patients visit us. If patients want to see better, even if you diagnose ocular allergies, dry eye or glaucoma, you won't fulfill their needs unless you provide specific vision correction recommendations commensurate with the demands of their daily lifestyles.

Why Dispense from the Chair?

As a practicing OD, you're the eyecare expert. You're examining patients and learning firsthand what their eyecare needs will be. Even if you have a staff of certified opticians, you should be the one making specific suggestions about vision correction, because your recommendations will deliver the very best visual outcomes. Afterward, it's up to each patient to accept your suggestions, but whether they do or not shouldn't deter you from this important practice.

Day in the Life of Doctor-driven Dispensing

In my office, we have six exam rooms, a large dispensary, four doctors and five opticians, most of whom are certified by the American Board of Opticianry. The communication style between doctors and patients and opticians comes from various best practice management strategies. I refer to it as the "baton pass." Others call it the "hand off."

Here's what I do in my office. After I complete a patient exam, I press a button on the intercom system to ask an eyewear consultant to come to the exam room. While I wait for her to arrive, I discuss my exam findings with the patient. I address the patient's complaints based on his history, discuss visual needs and make specific vision correction recommendations. I describe the different lens technologies and lens treatments available and discuss treatments for any systemic or ocular disease the patient may have. I always ask each patient, "Do you have any questions that I haven't answered for you today?"

When the eyewear consultant enters the exam room, I introduce her to the patient and discuss visual correction recommendations, such as brands of progressive addition lenses (PALs), A/R treatments, lens materials and tints. This shows the patient that I've met his visual needs before he's "handed off" to the dispensary to choose frames. The optician reconfirms and supports my recommendations by choosing eyewear based on my decisions. It's important to suggest vision correction options that will fit patients' lifestyles, whether they work at a computer every day or play sports. Patient satisfaction and enthusiasm will be evident when he views the computer with better visual clarity than ever before, and he doesn't have to raise his head to look through bifocals.

Implementing Doctor-driven Dispensing

If you'd like to introduce doctor-driven dispensing to your practice, here are some guidelines you can follow:

■ Keep abreast of the latest spectacle lens technologies and treatments. Spectacle lens technology is evolving as quickly as computers and high-definition TV. So it's important for you to fully understand the benefits of these technologies and how to prescribe them. Lens companies and practice management experts have developed programs to help you and your staff in this regard.

If you don't have a dispensary, you'll need to be even more proactive in explaining to patients how each of your vision correction recommendations will meet their specific visual needs. You also can educate yourself by visiting the booths of manufacturers and laboratories that specialize in spectacle lens technology the next time you attend an optometry conference.

■ Listen carefully. While examining patients, ask questions about the type of work they do (computer usage), the hobbies they enjoy (needlework, photography, fishing) and the sports they play (rock climbing, baseball, flying or golf). Then listen to the answers. What they say will help you choose the best vision correction options for them.

■ Give patients recommendations at the end of their exam. As an optometrist, you wouldn't write a prescription for an antibiotic without specifying which medication and giving instructions on how to use it, nor would you write a prescription for soft contact lenses without naming the brand, discussing the wear schedule and how to care for them. So remember to specify the brand name of the PAL, the type of lens material and lens treatment, the antireflective coating and the polarized or computerspecific tint when writing prescriptions for spectacles.

■ Provide patients with copies of their prescriptions in the exam room or at the front desk. With prescriptions in hand, patients will have written documentation, so to speak, of your recommendations. Since many patients delay purchasing additional eyewear, the written prescription will serve as a reminder of your suggestions.

Don't Take Vision Care Plan Limitations to Heart

When you practice doctor-driven dispensing, don't let the limitations of managed vision care plans deter you from recommending the latest lens technologies. Your priority is to ensure patients receive the best vision correction solutions possible. Some of the better vision care plans allow patients to choose upgrades, such as the newest free form, high-definition progressive addition lenses at minimal cost. Many patients will agree that it's money well spent.
Unfortunately, some plans don't allow patients to choose anything except the basic lenses. But, again, don't let this deter you. To bypass this obstacle, you and your staff can recommend the patient purchase back-up eyeglasses or sunglasses through the restrictive vision plan, but go outside the plan to buy the best eyewear for daily use.

Take the Plunge

As a new OD, be proud that you come from a long line of clinicians who delivered the best visual solutions to patients. You can, too, with doctor-driven dispensing. Adopting this practice for spectacle corrections is no different than offering the best contact lens systems or pharmaceutical treatments for eye disease. To be successful, commit to a system for recommending the best vision care options that will meet all of your patients' visual needs. You'll have happier patients and a thriving practice! nOD

Dr. Kehoe is president of the American Optometric Association. He's worked closely with students at all U.S. optometry schools during his tenure on the AOA board, beginning in 1999. He's a senior partner in three private practices in central Illinois, based in Galesburg, Ill. His daughter Alexandra is a student at NOVA College of Optometry.